Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 54-year-old man is seen for follow-up evaluation of a tremor in his upper extremities that has been present since age 20 years. The tremor was mild for many years and did not interfere with his work but has become more prominent in recent years. He has difficulty writing and using utensils ...

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Spend spend spend -- that’s the push by marketers and websites this time of year. Except from me. Here are three holiday gift things nobody needs. Save your money, or buy something else if you must, but stay away from today’s featured items: 1. Crib bumpers. The American Academy of Pediatrics has called for banning these things since 2007, but they’re still sold. And they’re still killing babies. A November ...

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The clues are usually there, even in the hardest of cases. They just aren’t presented to you on a silver platter. Gwen Stephenson had an ill-defined polyarthritis and had been on methotrexate for some time. Her rheumatologist, Norm Fahler, had tapered her off the medication while keeping an eye on her inflammatory markers and they had leveled off at just above the normal range. Seven or eight years ago, Gwen had suffered ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 28-year-old woman is evaluated for a 1-week history of progressive dyspnea and fatigue. She was diagnosed with Hodgkin lymphoma 2 months ago and is receiving chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). She takes no other medications. On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 134/82 mm ...

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asco-logoWhen is an advocate not an advocate? When should a spouse step back and let the husband make a treatment decision? When should an adult child of a man with prostate cancer let their father decide what is best for him? These are questions that, fortunately, I don’t have to ask all that often. Most men I see for prostate cancer ...

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The "necessity-burden monster" are words of my own choosing, and does not reflect any authoritatively-stated or generally-accepted health care paradigm.  It is, for me, an apt summation for how the progressive stages of the administrative side of health care have become a degeneration to the original intention of keeping medical records: to assist in patient care. What it has undergone, particularly in the last twenty years or so, and when compared to the ...

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It was recently World Antibiotic Awareness Week and Get Smart About Antibiotics Week. According to the CDC, 2 million people in the United States become infected with antibiotic-resistant bacteria and 23,000 people die from such infections each year. What's worse is that antibiotic resistance continues to increase. "To give you an idea of how high the pressure is to prescribe antibiotics, I didn't get a job once because during the interview ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old woman is evaluated during a routine follow-up appointment. She has gastroparesis associated with long-standing type 2 diabetes mellitus. Improved blood sugar control and efforts to eat small, frequent meals did not result in symptom improvement. In addition to these interventions, metoclopramide was started 6 months ago, after which her nausea ...

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Gluten is in the news again. Gluten and probiotics are among the two dietary issues that most consume my patients. I am asked for my opinion on them several times each week. Although my opinion is solicited, these patients have largely already made up their own minds as they are often avoiding gluten and swallowing zillions of "good bacteria" with zeal and enthusiasm. Why do they do this in the absence ...

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Several weeks ago, I was running late to my afternoon clinic. Literally, I could not move my feet fast enough. Reminiscent of 1990s childhood computer games, my Oregon Trail tempo was somewhere between strenuous and grueling. Lunch in hand, I slid into clinic just as the nurse was readying the chart of my first patient. I stuffed my lunch into the desk drawer, read the name off the chart, and ...

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